General Surgery Principles Practice Questions

Q: Most common cause of esophageal perforation at the site of cricopharynx -

Iatrogenic. ***Iatrogenic*** - Most esophageal perforations, especially at the cricopharyngeal level, are **iatrogenic**, typically occurring during **endoscopic procedures** such as esophagogastroduodenoscopy (EGD), transesophageal echocardiography (TEE), or esophageal dilation. - The cricopharynx (or upper esophageal sphincter) is a narrow, relatively weak area of the esophagus, making it susceptible to injury during instrument passage. - Accounts for approximately **50-70%** of all esophageal perforations at this site. *Spontaneous* - Spontaneous esophageal perforation (Boerhaave syndrome) usually occurs in the **distal esophagus** following episodes of severe retching and vomiting. - It is far less common in the cervical esophagus or cricopharyngeal region compared to iatrogenic causes. *Foreign body* - Foreign body impaction can cause esophageal perforation, particularly at anatomical narrowing points. - However, at the cricopharynx level, **iatrogenic injury during endoscopic removal** of foreign bodies is more common than direct perforation from the foreign body itself. *Traumatic* - **External blunt or penetrating trauma** to the neck can cause esophageal perforation, but this is less common than iatrogenic causes at the cricopharynx. - While trauma can certainly cause perforation, instrument-related perforations during medical procedures are statistically more frequent in this area.

Q: Incomplete casting can be due to:

All of the options.. ***All of the options.*** - All listed factors—**low casting pressure**, **insufficient venting**, and an **inadequate or too small sprue**—can prevent molten metal from completely filling the mold cavity during casting. - Incomplete casting is a common issue in foundry practice, and addressing these collective issues is crucial for achieving high-quality castings. *Low casting pressure.* - **Low casting pressure** means the molten metal is not pushed into the mold cavity with enough force to completely fill all parts. - This can lead to **voids** or **unfilled sections** in the final cast object. *Insufficient venting.* - When there is **insufficient venting**, trapped gases within the mold cannot escape as the molten metal fills the cavity. - This results in **incomplete filling** and porosity, as the gas pockets block the flow of metal. *Inadequate or too small sprue.* - A **sprue** that is either **inadequate** in design or **too small** in diameter restricts the flow of molten metal into the mold. - This limitation in metal flow can prevent the mold from being entirely filled, leading to incomplete casting.

Q: The material used in vertebroplasty is -

Polymethyl methacrylate. ***Polymethyl methacrylate*** - **Polymethyl methacrylate (PMMA)** is a commonly used **bone cement** in vertebroplasty due to its biocompatibility and mechanical properties. - PMMA rapidly polymerizes in situ, providing **structural support** and **stabilization** to the fractured vertebral body. *Polyethyl methacrylate* - **Polyethyl methacrylate** is another acrylic polymer, but it is less commonly used as a bone cement in vertebroplasty compared to PMMA. - It might have different handling characteristics or mechanical strength than PMMA, making it less ideal for this specific procedure. *Isomethyl methacrylate* - **Isomethyl methacrylate** is not a standard or recognized bone cement used in vertebroplasty. - The prefix "iso-" indicates an isomer, but this specific compound is not typically employed in medical procedures like vertebroplasty. *Isoethyl methacrylate* - **Isoethyl methacrylate** is also not a recognized or standard material used for bone cement in vertebroplasty. - Similar to isomethyl methacrylate, it is not a widely adopted or suitable material for providing structural support in vertebral fractures.

Q: Pseudoclaudication is caused by:

Lumbar canal stenosis. ***Lumbar canal stenosis*** - **Pseudoclaudication**, also known as **neurogenic claudication**, is a classic symptom of **lumbar spinal stenosis**. - This condition involves narrowing of the **spinal canal**, which compresses the **nerve roots** and causes pain, numbness, or weakness in the legs during walking. *Aortic aneurysm* - An **aortic aneurysm** is a localized **dilation of the aorta** and typically causes symptoms due to **rupture**, **compression of adjacent structures**, or **thromboembolism**. - It does not directly cause gait-dependent leg symptoms that characterize pseudoclaudication. *Peripheral vascular disease* - **Peripheral vascular disease (PVD)** causes **vascular claudication**, which is characterized by reproducible muscle pain with exercise due to **ischemia**. - Unlike pseudoclaudication, PVD pain is typically relieved by **rest** and is less affected by posture. *Spinal cord compression* - While **spinal cord compression** can cause neurological deficits, it typically presents with **upper motor neuron signs** (e.g., hyperreflexia, spasticity) below the level of compression. - These symptoms are usually more constant and severe than the intermittent, posture-related symptoms of pseudoclaudication, which primarily affects nerve roots.

Q: Cushing ulcers are:-

Stress ulcers in head injury. ***Stress ulcers in head injury*** - **Cushing ulcers** are acute **gastric or duodenal ulcers** that develop after a severe **head injury** or other central nervous system trauma. - The pathophysiology involves **vagal overstimulation** due to increased intracranial pressure, leading to hypersecretion of **gastric acid** and reduced mucosal blood flow. *Stress ulcers in hiatus hernia* - A **hiatus hernia** is a condition where part of the stomach protrudes through the diaphragm into the chest cavity, which can predispose to reflux and esophagitis. - While patients with hiatus hernia might develop ulcers, these are not specifically termed Cushing ulcers, and the primary cause is mechanical or reflux-related, not neurological. *Stress ulcers in burns* - **Stress ulcers** that occur in burn patients are known as **Curling ulcers**, not Cushing ulcers. - These are typically caused by **hypovolemia, vasoconstriction**, and **ischemia** of the gastrointestinal mucosa due to significant fluid loss and systemic inflammatory response. *Stress ulcers in depression* - **Depression** is a mood disorder that can influence gastrointestinal function through the **gut-brain axis**, potentially affecting motility and visceral hypersensitivity. - However, depression is not directly associated with the formation of acute stress ulcers like Cushing ulcers, which are primarily linked to severe CNS injury.

Q: Which statement about pilonidal sinus is false?

Usually occurs after 40. ***Usually occurs after 40*** - This statement is **false** because pilonidal sinus typically affects younger individuals, particularly those between **15 and 30 years of age**. - Its incidence significantly **decreases after the age of 40**, making late onset uncommon. *More common in males* - This statement is **true** as pilonidal sinus has a **higher prevalence in males** than females, with a male-to-female ratio of about 3:1 to 4:1. - This increased prevalence is often attributed to **hairiness** and certain occupational or lifestyle factors more common in men. *Mostly occurs in midline* - This statement is **true** as pilonidal sinuses primarily develop in the **natal cleft**, specifically in the **midline** between the buttocks. - They often begin as small pits or tracts at the top of the gluteal fold, allowing **hair and debris to collect**. *Associated with obesity* - This statement is **true** because **obesity** is a recognized risk factor for the development of pilonidal sinus. - Increased weight can lead to **deeper natal clefts** and increased skin friction, which can trap more hair and promote the formation of cysts and sinus tracts.

Q: A 50-year-old male presents with an irreducible groin swelling. What is the most likely diagnosis?

Inguinal hernia. ***Inguinal hernia*** - An **irreducible groin swelling** in a 50-year-old male is most commonly an incarcerated **inguinal hernia**, which is a surgical emergency. - **Inguinal hernias** are more prevalent in males due to the descent of the testes through the inguinal canal. *Femoral hernia* - While also presenting as a groin swelling and susceptible to irreducibility, **femoral hernias** are much more common in women. - They typically present as a swelling **below the inguinal ligament** and medial to the femoral vessels. *Hydrocele* - A **hydrocele** is a collection of fluid around the testis, which usually presents as a **transilluminable** scrotal swelling. - It is typically **reducible** and not associated with a mass in the groin proper. *Lipoma* - A **lipoma** is a benign fatty tumor that can occur anywhere in the body, including the groin. - However, unlike a hernia, it is typically **soft**, **mobile**, and generally **not irreducible** or associated with bowel contents.

Q: A 55-year-old male presents with a painful bulge in the groin that becomes more prominent when standing. Physical examination confirms an inguinal hernia. What is the definitive treatment?

Hernioplasty. ***Hernioplasty*** - **Hernioplasty** (mesh repair) is the definitive surgical treatment for inguinal hernia, involving either open (Lichtenstein) or laparoscopic (TEP/TAPP) approaches using mesh to reinforce the abdominal wall. - This procedure addresses the underlying anatomical defect, preventing complications such as **incarceration** or **strangulation**, which can be life-threatening. - Modern mesh-based repair has lower recurrence rates compared to traditional tissue repair (herniorrhaphy). *Truss application* - A **truss** is a supportive device that applies external pressure to the hernia site to keep it reduced. - It is considered a temporary measure to manage symptoms and is **not a definitive treatment** as it does not repair the structural defect. *Observation* - **Observation** alone may be considered in asymptomatic or minimally symptomatic patients with reducible hernias (watchful waiting). - However, this patient is **symptomatic** (painful bulge), making surgical repair the preferred definitive approach to prevent complications like **incarceration**. *Antibiotic therapy* - **Antibiotic therapy** is used to treat bacterial infections. - An **inguinal hernia** is a structural defect, not an infection, and therefore antibiotics are not a relevant treatment.

Q: An orthopedic surgeon is repairing a fracture in the distal radius. Which structure must be carefully protected because of its proximity to the surgical site?

Median nerve. ***Median nerve*** - The **median nerve** closely tracks the flexor tendons and is situated centrally in the wrist, making it highly vulnerable during distal radius fracture repair, especially in cases of displaced fractures or open reduction procedures. - Injury can lead to **carpal tunnel syndrome** symptoms, including numbness and weakness in parts of the hand innervated by the median nerve. *Radial nerve* - The **radial nerve** and its branches, such as the superficial radial nerve, are located on the dorsoradial aspect of the wrist. - While it can be injured, it is generally less commonly damaged during a standard distal radius fracture repair approach compared to the median nerve. *Ulnar nerve* - The **ulnar nerve** runs along the ulnar side of the wrist, within Guyon's canal, which is anatomically distinct from the primary surgical approaches to the distal radius. - Its distance from the typical surgical field for distal radius fractures makes it a less common site of iatrogenic injury during this specific procedure. *Brachial artery* - The **brachial artery** is located in the arm, proximal to the elbow, and is not in the immediate vicinity of a distal radius fracture repair. - Injury to the brachial artery is highly unlikely during surgery on the wrist.

Q: A central line is inserted into a patient for chemotherapy administration. What is the most appropriate position for the tip of the catheter?

Superior vena cava. ***Superior vena cava*** - The **superior vena cava (SVC)** is the ideal placement for a central line tip, approximately at the junction of the SVC and the **right atrium**. - This position ensures rapid dilution of infusates, such as **chemotherapeutic agents**, minimizing vascular irritation and the risk of vein thrombosis or damage. *Pulmonary artery* - Advancing a central line into the **pulmonary artery** is typically done for **pulmonary artery catheterization** (e.g., Swan-Ganz catheter) to monitor hemodynamic pressures, not for routine chemotherapy. - Placement here would carry a significant risk of **pulmonary artery perforation** or obstruction. *Inferior vena cava* - The **inferior vena cava (IVC)** is accessed via lower extremity veins (e.g., femoral vein) and is not generally preferred for chemotherapy administration due to higher rates of **deep vein thrombosis** and less optimal dilution compared to SVC placement. - Catheter tips placed in the IVC are primarily for filters or infusions in patients with limited upper body access. *Right atrium* - While close to the SVC, positioning the catheter tip directly within the **right atrium** is generally avoided due to the risk of cardiac irritation, leading to **arrhythmias** or local damage. - The turbulent flow within the atrium can also contribute to **thrombus formation** around the catheter tip.

Question 1

Most common cause of esophageal perforation at the site of cricopharynx -

Accepted Answer

Iatrogenic

Answer

Spontaneous

Answer

Foreign body

Answer

Traumatic

Question 2

Incomplete casting can be due to:

Accepted Answer

All of the options.

Answer

Low casting pressure.

Answer

Insufficient venting.

Answer

Inadequate or too small sprue.

Question 3

The material used in vertebroplasty is -

Accepted Answer

Polymethyl methacrylate

Answer

Polyethyl methacrylate

Answer

Isomethyl methacrylate

Answer

Isoethyl methacrylate

Question 4

Pseudoclaudication is caused by:

Accepted Answer

Lumbar canal stenosis

Answer

Aortic aneurysm

Answer

Peripheral vascular disease

Answer

Spinal cord compression

Question 5

Cushing ulcers are:-

Accepted Answer

Stress ulcers in head injury

Answer

Stress ulcers in hiatus hernia

Answer

Stress ulcers in burns

Answer

Stress ulcers in depression

Question 6

Which statement about pilonidal sinus is false?

Accepted Answer

Usually occurs after 40

Answer

More common in males

Answer

Mostly occurs in midline

Answer

Associated with obesity

Question 7

A 50-year-old male presents with an irreducible groin swelling. What is the most likely diagnosis?

Accepted Answer

Inguinal hernia

Answer

Femoral hernia

Answer

Hydrocele

Answer

Lipoma

Question 8

A 55-year-old male presents with a painful bulge in the groin that becomes more prominent when standing. Physical examination confirms an inguinal hernia. What is the definitive treatment?

Accepted Answer

Hernioplasty

Answer

Truss application

Answer

Observation

Answer

Antibiotic therapy

Question 9

An orthopedic surgeon is repairing a fracture in the distal radius. Which structure must be carefully protected because of its proximity to the surgical site?

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Brachial artery

Question 10

A central line is inserted into a patient for chemotherapy administration. What is the most appropriate position for the tip of the catheter?

Accepted Answer

Superior vena cava

Answer

Inferior vena cava

Answer

Pulmonary artery

Answer

Right atrium

General Surgery Principles — MCQs

General Surgery Principles — MCQs

On this page

Practice by Chapter

Want unlimited practice?